Health Connection - November 2021

Keeping Burnout at Bay

By Edward Vander Clute, LCSW

It’s official: burnout is an international phenomenon, described by the World Health Organization (WHO) as “a syndrome resulting from chronic workplace stress.” In fact, the WHO is currently developing guidelines to promote mental well-being in the workplace. While that’s nice to know, ­it’s not necessarily helpful if you’re experiencing burnout in the here and now.

What is Burnout?

Burnout is a state of emotional, physical, and mental exhaustion due to prolonged stress at work—whether that work is in an office or caring for family at home. The demoralizing effects of burnout can seep into every aspect of your life, even during downtime:

• Physical symptoms. You feel tired and drained. You notice changes in your appetite and sleep patterns. You have frequent headaches and muscle pain. You get sick more frequently.
• Emotional signs. You feel a constant sense of dread. Work seems boring or overwhelming. You doubt your own abilities and feel like a failure. You feel unappreciated, as though nothing you do can make a difference. You have a sense of being trapped and helpless. You are cynical, negative, and emotionally detached.
• Behavioral signs. Your productivity declines. You feel isolated from others and withdraw from your responsibilities at work and at home. You are short-tempered and impatient. You procrastinate and may start coming in late, leaving early, or skipping work entirely. You turn to food, drugs, or alcohol to help you cope.

What Causes Burnout?

Working in a chaotic, pressured, overly demanding environment can lead to burnout. Conversely, so can a job you find boring and monotonous. Lack of recognition and feeling professionally “stuck” can also contribute. People with high achieving, “type A” personalities may experience burnout because of their perfectionist tendencies and reluctance to delegate tasks.

Building Your Resilience

There’s no doubt that changing jobs or even careers can eliminate burnout, but that’s not always a realistic short-term option. What’s more, it’s hard to find the energy and determination to make a career move when you’re experiencing burnout. Below are some tips that can help you start feeling better at work and home.

• Take time off. Go on vacation, take a few sick days, or ask for a leave of absence. Just give yourself an opportunity to recharge. Think about what really matters to you and reevaluate your goals, hopes, and dreams.
• Reach out to others. Talk to a therapist or a good listener who knows and cares about you. Don’t make the encounter about just about venting: plan fun activities to get your mind off work. Work friendships can be an outlet when you’re having a rough day, but beware of chronic complainers since you’ll just make each other feel worse.Join a religious, social, or support group, or get active with a professional association if your line of work has one.
• Do some good. If you feel like you can’t make a difference at your job, look for opportunities to do so elsewhere. Volunteer at your local school, hospital, or senior citizen’s home. If there’s a cause you feel strongly about, look for opportunities to get involved. Volunteering will boost your sense of self-worth and provide opportunities to meet new people. Look for opportunities that match your preferences here or here.
• Set boundaries. Learn how to say “no” to requests on your time, both at work and at home. Give yourself the time to say “yes” to things you really want to do and people you really want to see.
• Take technology breaks. Set a daily disconnect time. Turn off your laptop, tablet, and smartphone. Get off social media. Take a walk or read a book and leave your devices to their own devices.
• Get creative. Revive an old hobby or start a new one. Try not to be self-conscious about the results. You don’t have to be Jimmy Hendrix or Picasso to start guitar or art lessons.
• Practice relaxation techniques. Meditate or do yoga or tai-chi. Check out MarinHealth's YouTube channel for classes in meditation and JinShin Jyutsu, an ancient form of healing that harmonizes your life energy.
• Exercise. A workout is a great antidote to burnout. Exercise reduces stress and triggers the release of mood-elevating endorphins. Try walking, running, swimming, weight-training, martial arts, dance class... whatever strikes your fancy. If at first you don’t have the energy to do a 30-minute workout, start with several 10-minute bursts of activity a day. A 10-minute walk can elevate your mood for a couple of hours.
• Eat right. A healthy diet can have a positive effect on mood. The quick boost you get from so-called comfort foods like French fries and ice cream ends in a crash in mood and energy. Instead, choose foods with mood-elevating Omega-3 fatty acids, such as salmon, walnuts, and avocados. Cut down on sugar, unhealthy fats, and processed foods.
• Avoid caffeine, nicotine, and alcohol. It’s okay to start the day with a cup of java but too much caffeine can worsen anxiety and cause sleep problems. Tobacco’s carcinogenic effects are well-documented, and smoking has a negative effect on mood—nicotine is a powerful stimulant that can raise your anxiety level. Alcohol is a depressant, especially as it wears off. Drinking before bed disrupts the sleep cycle so that you get less deep REM sleep. Alcohol can also induce nightmares and has a diuretic effect, which may cause you to wake up in the middle of the night.

If you’re feeling burnt out, it’s essential to take action now. Over time, burnout can have serious mental health consequences—it's a risk factor for depression and substance abuse, and can even lead to suicide. If you are in need of support, learn about behavioral healthcare treatment at MarinHealth Medical Center or call 1-415-925-8808 to speak with a clinical social worker who can point you in the right direction.

Edward Vander Clute is a licensed clinical social worker at MarinHealth Psychiatry | A UCSF Health Clinic.

It's Holiday Accident Season: Tips for Staying Safe

By Sadiq Sadeeq, MD

Icy sidewalks, which cause hundreds of thousands of falls each year, may not be “a thing” here in the Bay Area, but we are not exempt from seasonal accidents and illnesses.

Below are a few tips to help you make it through the holidays injury-free.

Decorating Dangers

Putting Rudolph on the roof is a perilous activity. According to the CDC, nearly 6000 people are injured during holiday decorating each year. To reduce the risk of falling:

• Place ladders on a level surface. Space the bottom of the ladder one foot from the wall for every 4 feet in height. Stay centered on the ladder—move the ladder rather than reaching too far to the side.
• Open stepladders all the way and lock them.
• Don’t substitute furniture, or anything else, for a ladder.

Fire Hazards

Fire safety should be top of mind this holiday season, especially during this historic drought:

• Test your smoke alarm and replace the batteries.
• Choose the freshest, greenest Christmas tree you can find. Needles should not fall off easily and the tree’s base should be sticky with resin.
• Place your tree at least 3 feet away from heat sources, including HVAC vents, radiators, and fireplaces. Water it daily and get rid of it soon after Christmas—a dry tree can catch fire in seconds.
• Don’t use outdoor lights indoors. Check extension cords for cuts or fraying and throw out lights with loose connections, cracked or broken sockets, or frayed or bare wires.
• Always turn off the tree lights when you go to bed or leave the house.
• Place lit candles, matches, and lighters out of the reach of children. Blow out any decorative or menorah candles when you leave home or go to bed.

Partying Too Heartily

Here’s a sobering statistic: according to the National Institute on Alcohol Abuse and Alcoholism, 40% of holiday highway deaths are alcohol related. If you are out and plan on drinking, arrange for transportation home. If you’re the host and a guest is inebriated, don’t hesitate to take their keys or invite them to sleep it off on your couch.

Food Safety

Food poisoning can take all the fun out of a holiday family feast. Follow these tips to keep holiday fare safe:

• Use a food thermometer to ensure that meats are thoroughly cooked.
• Keep hot food hot and cold food cold. Avoid the danger zone, between 40°F and 140°F, when bacteria grow most rapidly. Refrigerate or freeze leftovers within two hours. Set your refrigerator at or below 40°F and your freezer at or below 0°F.
• Store raw meat and poultry in a separate part of the refrigerator, in containers and sealed plastic bags.
• Thaw your turkey in the refrigerator, a sink of cold water (changing the water every 30 minutes), or the microwave. Avoid thawing foods on the counter.
• Wash your hands before, during, and after food preparation.

Cook Carefully

• If you need to peek into a hot pot, tilt the lid so any steam is aimed away from you.
• NEVER pour water on a grease fire.
• Clean spills immediately, whether on the floor or counters.
• Keep knives sharpened. Sharp knives are less likely to slip and catch your fingers. Cut over a cutting board and always aim the knife away from your body.
• Never toss a knife into a sink full of dirty water where someone could reach in and get cut.
• Never leave the kitchen when cooking on a stove top.

Watch Your Back

With so much to get done preparing for the holidays, it’s easy to move too fast, reach too high, or lift too much. Carry heavy bags and boxes one at a time and use proper lifting techniques: keep your back straight and let your legs do the work. Use a stepladder rather than overextending your arms and risking a shoulder injury.

Choking Hazards

A recent study found that people are 10 times as likely to get food stuck in their throats during the holidays. Adults may eat too fast, or take large bites and not chew enough, especially if they’ve been drinking. People taking medications that reduce saliva output, stroke survivors, or older adults with dementia are especially at risk.

No matter how careful you are, accidents and illnesses can still happen. For minor injuries or an illness that needs treatment when your regular doctor isn’t available, you can count on exceptional care from the team at MarinHealth Urgent Care in San Rafael, which treats patients three months of age and up, and is located just down the hall from MarinHealth Outpatient Imaging Center, allowing for quick diagnosis of fractures and sprains during daytime hours. We also offer after-hours care specifically for children—provided by pediatricians—at our Pediatric After-Hours Care Clinic in Larkspur. Of course, for serious injuries or emergencies, call 911.

Sadeeq Sadiq, MD is an emergency medicine physician and Medical Director of MarinHealth Urgent Care | A UCSF Health Clinic.

The Pediatric COVID-19 Vaccine: Q & A With Dr. Karin Shavelson

When it comes to advising parents about the pediatric COVID-19 vaccine, Karin Shavelson, MD, FAAP, Chief Medical Officer at MarinHealth^®, has the ideal expertise. She joined MarinHealth in 2019 as the Medical Director of the Pediatric Hospitalist Group and has more than 15 years’ experience as a board-certified pediatric hospitalist, and has been one of the leaders of MarinHealth's COVID-19 pandemic response. We asked her some of the most common questions about the pediatric COVID-19 vaccine.

What is MarinHealth’s recommendation regarding kids and the COVID-19 vaccine?

In agreement with the Centers for Disease Control and Prevention (CDC) and the California Department of Public Health, we absolutely recommend that children five and older be vaccinated. We have been vaccinating children ages 12 and older for several months. On November 2, the CDC issued a recommendation that children 5 to 11 years old be vaccinated against COVID-19 with the Pfizer-BioNTech pediatric vaccine.

Right now, the only COVID-19 vaccine approved for youngsters is Pfizer. Will that change? Is there any reason to wait for another vaccine for kids?

Other COVID-19 vaccines are definitely being tested for use in children; however, there is no reason to wait. In fact, time is of the essence as we approach the holidays. Many children will be going to indoor events, traveling, and visiting family. The odds of their being exposed and spreading the virus will be much higher. I recommend vaccinating your child as soon as possible.

The recommended dosage is two shots, three weeks apart. Do you anticipate the need for boosters after that?

We don’t have all the data yet so we can’t say for certain. What we do know is that the pediatric immune system appears to be behaving the same ways as the adult immune system. That would indicate that yes, boosters may be needed in the future, but we just don’t yet have the data to make that call.

I heard that some children may need an additional dose for medical reasons.

Yes, children 12 and older who are immunocompromised because of cancer or certain medical conditions, such as type 1 diabetes, may need an additional dose. However, this depends on the child’s medical condition and general health. It’s a very individualized decision that you should discuss with your child’s healthcare provider.

Where can I get my child vaccinated?

Marin County has a robust vaccine infrastructure. Some schools are offering the vaccine on-site. Marin County Public Health is partnering with Safeway Pharmacies to offer “Pediatric Supersites” that can vaccinate as many as 1,000 children a day. Pediatric vaccines are also available at some of Marin County’s pop-up locations, certain pharmacies, and some pediatricians’ offices. Not all pharmacies offering the Pfizer vaccine are vaccinating children ages 5-11, so check online. The best place to get specific information is on the Marin Health and Human Services website.

What are the possible side effects of the Pfizer-BioNTech COVID-19 vaccine in younger children?

Potential side effects are similar to those experienced by people ages 12 and older. Their arm will typically be sore where the shot was given. You might see some fatigue, or flu-like symptoms like fever, headache, chills, and muscle pain. Some people have nausea or a decrease in appetite.

As with adults, side effects tend to occur within two days after vaccination and last one to three days. They are more common after the second shot. Anecdotally, some physicians are noting anxiety symptoms such as an increased heart rate and lightheadedness—probably because, as most of us know, not many kids like getting shots!

Can you address some of the more common misconceptions circulating regarding COVID-19 and vaccinations?

• The vaccine was rushed and isn’t safe for kids. This is by far the most common concern. The fact is, mRNA vaccine technology has been used for decades, and while COVID-19 is new, coronaviruses have been around for a long time. Vaccinating your child is much safer than having your child get COVID-19.
• Children don’t get very sick from COVID-19. While that is true for many children, I have seen some get quite ill. Children may be hospitalized and even die, and those with chronic conditions are especially vulnerable.
• The vaccine will change my child’s DNA. The vaccine cannot affect or change a person’s DNA. mRNA vaccines prompt cells to make a protein that triggers an immune response against the COVID-19 virus. The mRNA in the vaccine does not interact with or affect the DNA of your cells.
• The vaccine could give my child COVID-19. That is not how this particular vaccine works. It does "trick" your immune system into thinking you have COVID, but your body is not actually infected with the COVID-19 virus.
• The vaccine could make my child infertile. This misinformation was traced back to a false Facebook post. We have no evidence whatsoever that the vaccines have any impact on fertility. What we are seeing is a possible impact on the fertility of people with post-acute COVID-19 syndrome, the so-called “long haulers.”
• My child already had COVID-19 so they are immune. Reinfection does occur. Unfortunately, immunity wanes relatively rapidly over time and is simply not as strong or robust as immunity from the vaccine.

What do I do if my child has the sniffles? Should I keep them home? Get them tested?

This is a really tough situation for parents right now. To be safe, every case of the sniffles really needs to be evaluated, particularly for children under five. You should have a conversation with your pediatrician and get your child tested. Rapid antigen tests are a good screening tool for those who exhibit symptoms and it’s not a bad idea to have a test kit on hand at home. All the pharmacies have them, and you can also order them on Amazon. Some insurance companies cover the test, so be sure to check. If you believe your child has been exposed to COVID-19, you should call your pediatrician for advice even if your child does not have symptoms.

What should I do if my child tests positive?

If you haven’t called your pediatrician yet, do so at once. Treat the symptoms as you would a bad cold or flu. Ask your doctor about dosing for acetaminophen or ibuprofen and keep your child hydrated. It’s essential to avoid the spread of COVID-19 in the household and that’s especially challenging for families with more than one child under five. Often, transmission has already occurred. Follow the advice below to help protect your family from infection:

• The entire household needs to quarantine if there’s a child with COVID-19 in the home. Follow the recommendations of the California Department of Public Health.
• Designate ONE family member to care for the sick child.
• Keep the sick child isolated in one room of the house, open the window for ventilation, keep the door closed as much as possible and, if possible, deliver meals outside the bedroom door.
• Have everyone in the family wash their hands frequently and clean and disinfect any surfaces your child may have touched.

What can I do to help keep my child from contracting COVID-19 at school?

The single best step you can take is to get your child vaccinated. Marin has a robust 32 Point Plan for school COVID-19 safety. Recommendations may change as the pandemic evolves, and I would start there for the most current information on school safety measures.

The internet makes it easy for dangerous, false information regarding COVID-19 and the vaccines to spread, and once the rumors shared, they can be hard to debunk. I urge parents to take their questions to a trusted healthcare provider, listen to what they have to say, and follow their recommendations. Your pediatrician should always be your go-to resource for any concerns you have about your child’s health.

Investigating Insulin: Common Questions, Answered

By Linda Gaudiani, MD, FACE, FACP

November is Diabetes Awareness Month, and World Diabetes Day falls every year on November 14, the birthday of Canadian physician Dr. Frederick Banting, who discovered insulin at the University of Toronto in 1921. In honor of the 100th anniversary of the discovery of insulin, which drastically changed how we treat diabetes, we’re answering some of the questions we hear most often about insulin.

Will I gain weight while taking insulin?

Not necessarily! It depends on the type and amount of food you eat, and how your insulin is dosed and managed. Insulin is a hormone that allows your body to store glucose (sugar) inside your cells. When you eat, carbohydrates such as bread, pasta, and fruit are broken down into glucose. In order for that glucose to enter your cells, you need insulin. Insulin works like a key, which unlocks your cells to let the glucose in. Once inside, your cells use the glucose to give you energy. If you eat a large meal with lots of carbohydrates, your body will need more insulin to store all the glucose from the food inside your cells, which may result in weight gain. However, if you eat a small meal with a limited amount of carbohydrates, your body will need less insulin to store the glucose from the food without causing weight gain.

I have heard that taking insulin can cause complications like blindness and amputations. Is it true?

No, this is not true. Insulin is a hormone that facilitates storage of glucose, the cell’s fuel, inside the cells for energy. When a person has diabetes, the body cannot make enough insulin and/or the insulin their body makes does not work properly. As a result, the glucose stays in the blood stream and over time causes damage to the blood vessels and nerves all over our body. Damage to the large blood vessels of the heart and brain can result in heart attack and stroke. Damage to the small blood vessels of the eyes and kidneys can result in eye and kidney disease. Damage to the nerves that impact the feet, as well as poor circulation, can result in foot problems and amputations.

As long as blood sugars are well controlled, having diabetes does not mean a person will end up with diabetes complications. However, untreated diabetes will result in having excess glucose in the blood over time, which can lead to diabetes complications. Taking insulin can reduce the amount of glucose in the blood and prevent diabetes complications, not cause them!

Will I become addicted to insulin if I start taking it?

No. Insulin is not addictive. Insulin is necessary for life functions. You know the expression, “one size fits all?” Well, when it comes to insulin, it’s the opposite. The amount of insulin a person needs depends on many factors, including body weight, age, food intake, duration of diabetes, and type of diabetes. Excess weight (especially around the waist) can result in insulin resistance, which is when insulin does not work properly. A person with insulin resistance may need more insulin to get blood sugars back to the target range.

Hormones produced during puberty and pregnancy make a person more insulin resistant, which can also affect the amount of insulin the person needs.

Diabetes can be progressive disease, meaning that over time, the pancreas will make less and less insulin. Therefore, a person that has had diabetes for many years may require more insulin than a newly diagnosed person whose pancreas is still producing insulin. Type 2 diabetes can be reversed if diagnosed and treated early.

Today insulin in also used in conjunction with many other very effective medications and monitoring systems that makes insulin use safer and easier.

If I’ve been prescribed insulin, does that mean I have the worst kind of diabetes?

No. If your physician recommends that you take insulin, it simply indicates that your body needs supplemental insulin to get your blood sugars to the target range. Both patients with type 1 and type 2 diabetes can take insulin.

Type 1 diabetes is an autoimmune condition where the body attacks and destroys the cells of the pancreas that make insulin, and people with type 1 diabetes must replace the insulin they are no longer capable of making. If your body cannot produce insulin, you must replace it.

Type 2 diabetes is a condition caused by a number of factors including genetics, age, ethnicity, diet, body weight, and lack of physical activity and other mechanisms that are highly individual. A person with type 2 diabetes may need insulin to get blood sugars to target in addition to other non-insulin medications and lifestyle changes.

“Bad Diabetes” is uncontrolled diabetes, not diabetes controlled with any particular agent, including insulin, which can be life-saving.

If I’m prescribed insulin, does that mean I will have to keep taking it for the rest of my life?

Not necessarily. Some people with type 2 diabetes are able to lower and sometimes even stop taking insulin by managing their diet, physical activity, and stress level. We know that weight loss and regular physical activity make insulin work better in the body. Sometimes the addition of Metformin and other oral and injectable medications can make the insulin you’re taking—or still making—work better, resulting in better blood sugar levels and enabling a reduction or discontinuation in the insulin dose.

Why should I put something unnatural like insulin in my body?

The insulin used to treat diabetes is safe to take and “natural.” While it is true that insulin is made in a laboratory, its molecular structure is identical to your own body’s insulin. Until 1982, all insulins used to treat diabetes came from animal sources such as cows or pigs. Unfortunately, in humans these animal-based insulins often resulted in allergic and immunologic reactions. Synthetic insulins were developed using modern methods that resulted in the availability today of insulins that mimic the human hormone and have few if any side effects in most people.

Insulin can even be a more effective way to get blood sugars to target with fewer side effects than other oral and injectable medications. Insulin is also the recommended medication of choice for children and many pregnant women with glucose intolerance or diabetes. It is safe to take as long as it is prescribed with care and patients are monitored closely.

Are you at risk for diabetes?

Find out with a quick, free Health Risk Assessment today: www.mymarinhealth.org/hra.

Linda Gaudiani, MD, is the Medical Director of the Diabetes Care Program at MarinHealth Medical Center and Co-Founder of MarinHealth Braden Diabetes Center.